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HomeMy WebLinkAboutBLD-23-005871 Office Use Only • . `� $e'rrnt `� o . .", 1 .3. !,Amount S D 9 47 - . ,- t` Permit expires 180 days from .. m issue date EXPRESS BUILDING PERMIT APPLICATI Er Ely 7., D TOWN OF YARMOUTH Yarmouth Building Department I 1 APR 21 2023 1146 Route 28 I South Yarmouth, MA 02664 e/TMENT (508)398-2231 Ext. 1261 By ________ CONSTRUCTION ADDRESS:62 op- c tr\ Sona." QD ASSESSOR'S INFORMATION: �/ Map: Parcel: r,Q OWNER: £Q1 I Shipp io� capraIn ci t Z[ (506)- 3_In 8-€32y NAME p ,/�c � '/ 'PfRESENTADDRR1ESS/� p ({i�'�n TEL. # CONTRACTOR: Fir 1. CO1 1,,r r UC' 'Of `3 0 2- Pr i C f `11 i i' 7, i') I q O —8' C NAME MAILING ADDRESS iJi i A')(„�5' TEL.# 1 s 13�, 61 3-1 /a000 9 Residential ❑Commercial Est.Cost of Construction$ I Home Improvement Contractor Lie.# 15GI i C Construction Supervisor Lie.# 10 ( 3 1- Workman's Compensation Insurance: (check one) J 0 I am the homeowner 0 I am the sole proprietor ® I have Worker's Compensation Insurance Insurance Company Name: R i St t - e1, til 1°S• Worker's Comp.Policy# t►V C(-15)- i 3 Li s WORK TO BE PERFORMEDZZ Tent El Duration (Fire Retardant Certificate attached?) Wood Stove_ Siding: #of Squares 2 Replacement windows:# Replacement doors: # Roofing: #of Squares 2 J (�)Remove existing*(max.2 layers) Insulation 171 I I Old Kings Highway/Historic Dist. 0)Replacing like for like Pool fencing I 1 *The debris will be disposed of at: 1 V ° U')r `a- rY 1 0 f U 1 C( (CI I a r Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial o tion of my license and for prosecution under M.G.L.Ch.268,Section I. •Applicant's Signature: ____ Date: i I a)I J c)-3 _ _ Owners Signature(or attachment) Date: Approved By: 'It/ Date: _-- ....,./ Building Official(o esi EMAIL A; SS: P� pAroct. ...�51 on a E Y 1� C Om Zoning District: Historical District: :r Yes "i No Flood Plain Zone: Yes . No Water Resource Protection District: Within 100 ft.of Wetlands: : Yes No i Yes _ No OV.1(1lits A message from the 4> , H y a th, Water V eyartment 611 . 99 Buck Island Road• West Yarmouth, MA 02673 •508-771-7921 ATTENTION HOME OWNERS AND CONTRACTORS!! Please note that the box shown below is property of the Yarmouth Water Department and is an important i part of the drinking water metering system. The Yarmouth Water Department utilizes these "End ° Points" to collect water usage readings from our customer's water meters. PLEASE DO NOT REMOVE THEM FROM YOUR HOME OR BUSINESS!! If work is being done in the vicinity of the End Point, please r take care to maintain the wiring and securely i '` -- °<< ' reinstall the End Point. If the End Point is damaged or lost, o its or the wires are broken, the Water _ - KK. , : _ Department will charge the property owner for any necessary labor and equipment needed to make the repairs. Please call the Water Department at 508-771-7921 with any questions or to schedule a repair. g Thank you for your assistance in kF fr keeping our water system running smoothly! { kq �P " � THANK YOU FOR YOUR HELP! For more information visit: I -� �$� ��« z� � ���: °�`, lil y: www.yarmouth.ma.us/139/Water . 1 ,„ , W_ hl , • The Commonwealth of Massachusetts to til tr, Department of Industrial Accidents R. 1 Congress Street,Suite 1©it Boston,MA 02114-2017 �Y www-mass.gov/dma Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/organization/Individual) ERIE CONSTRUCTION Address: 230 SECOND AVENUE, SUITE 130 City/State/Zip: WALTHAM, MA, 02451 phone . 781-790-8140 Art you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with employees(full andrar part-time).' 7. New construction 2.0I ant a sole proprietor or partnership and have no employees working for mein s. ❑Remodeling any capacity.[No workers'comp.insurance required] 3.0I am a homeowner doing all work myself.[No workers"comp.insurance required.)t 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property; I will 10®Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.©Plumbing repairs or additions 5 M 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance,./ 13.*Roof repairs 6.0 We arc a corporation and us officers have exercised their right of exemption per MGLc. 14.Q C3tlter 152,§1(4).and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number: I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:THE FIRST LIBERTY INSURANCE CORPORATION Policy#or Self-ins.Lic.#:WC6-Z51-293745-022 Expiration Date: 4/25/2023 Job Site Address: 6 a c"kp f SY 12DCity/StateIZip:S"j 1M l/ t h,/AR/ 1,(01-1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$t,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u e pains annd penalties of perjury that the information provided above is true and correcn Sina e: �� � Date: I (I V lJ`�3 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DocuSlgn Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 )-1 °%% % EIIEHOME Massachusetts Only: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Custom Remodeling Agreement Erie Home 3516 Granite Circle, Toledo, OH 43617 800-684-4628 eriehome.com Contractor License Numbers: 159905, CSFA-106394 Buyer Name: Earl Shipp Co-Buyer Name: Address: 62 Captain Small Road, S Yarmouth, MA, 02664 Phone Number: 5083985324 Email: earlshipp@comcast.net Reference: R060-014299 Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Erie Construction Mid- West, LLC. ("Contractor") as listed herein and on the accompanying Specification Sheet(s) in accordance with the terms and conditions described on each page of this Agreement and on each page of the attached Specification Sheet(s) (collectively, "Agreement"). Buyer(s)agrees to sign a Completion Certificate after Contractor has completed all work under this Agreement. Date of Contract: 4/11/2023 Purchase Price: $37,660.00 Estimated Start Date: 5/11/2023 Down Payment: $18,830 Estimated Completion Date: 6/11/2023 Balance Due Upon Completion: $18,830.00 Method of Payment: Cash Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings, changing, or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) has read this entire Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above. Buyer(s) also acknowledges that Buyer(s)was orally informed of Buyer's right to cancel this Agreement. '7 � 'ik duct N<�i i 7IIhIUNf,N"� - ��G'' �°.atd �Nrv* .;� ,hN�fllG�n �l I p �,��!� _ _ r. N�i i a ,.w ... l lh'r �3�� .- mar m (a o i, d +` o! R694t"`t 4...' inn nww rwz' '%tllf�' c r v�� Erie Home Representative Erie Home Representative Name: Nicholas Boarman Name: Signature: Signature: .—DocuSigned by: ‘Tya512Q82ADg f eZ 3 Date: DocuSign Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 Buyer Information Co-Buyer Information Name: Earl Shipp Name: Signature: Signature: DocuSigned by: Slr t-aitcD7171e2 3 Date: YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FOR MICHIGAN SALES ONLY, ADDITIONALLY, THE SELLER IS PROHIBITED FROM HAVING AN INDEPENDENT COURIER SERVICE OR OTHER THIRD PARTY PICK UP YOUR PAYMENT AT YOUR RESIDENCE BEFORE THE END OF THE 3-BUSINESS-DAY PERIOD IN WHICH YOU CAN CANCEL THE TRANSACTION. DocuSign Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 NOTICE OF CANCELLATION Customer Copy Date of Transaction: 4/11/2023 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract or Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Erie Construction Mid-West, LLC., at 3516 Granite Circle, Toledo, Ohio 43617, NOT LATER THAN MIDNIGHT OF 4/14/2023 I HEREBY CANCEL THIS TRANSACTION. Customer Signature: Date: DocuSin Envelope ID:EOBD1436-2FBD-4693-9DF4-6286A2752AB9 NOTICE OF CANCELLATION Erie Home Copy Date of Transaction: 4/11/2023 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract or Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Erie Construction Mid-West, LLC., at 3516 Granite Circle, Toledo, Ohio 43617, NOT LATER THAN MIDNIGHT OF 4/14/2023 I HEREBY CANCEL THIS TRANSACTION. Customer Signature: Date: DocuSign Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 Specification Sheet Buyer Name: Earl Shipp Co-Buyer Name: Address: 62 Captain Small Road, S Yarmouth, MA, 02664 Date of Contract: 4/11/2023 Phone Number: 5083985324 Reference Number: R060-014299 Buyer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services listed below, in accordance with the prices and terms described on this Specification Sheet and the Custom Remodeling Agreement, of which this Specification Sheet is a part. Additional terms and conditions are listed below. Shingle Profile: Fiberglass Shingle Color: Atlantic Blue Product(s) Low-Slope Roofing Fiberglass Roofing - Band 3 Remove 1 to 2 Asphalt Layers - Band 3 Complexity Charge (Skylight, Chimney, Cricket) - Band 3 Erie to remove existing roofing and properly dispose. Erie to furnish and install fiberglass dimensional shingle. Erie to furnish and install Radiant Barrier Synthetic Underlayment. Erie to furnish and install all accessories that may include drip edge, pipe boots, and flashing. Erie to vent roof properly. Erie to prep roof for low-slope application. Erie to remove existing roof prior to installing the new roof system Erie only roofing main home structure including garage, Erie 'NOT' roofing any other structures on the property Erie to roof facet/section of roof on right side with low slope material. Price includes all labor, material,warranty, and 100%job cleanup. It is agreed and understood by and between the parties that this Specification Sheet, along with the Custom Remodeling Agreement, constitutes the entire understanding between the parties, and there no verbal understandings, changing, or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read the entirety of this Specification Sheet. Erie Home Representative Erie Home Representative DocuSign Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 Name: Nicholas Boarman Name: Signature: Signature: —/DocuSigned by: Date e2A4' 1i/b23 Date: Buyer Information Co-Buyer Information Name: Earl Shipp Name: Signature: Signature: r—DocuSigned by: LA/ Sim '—C2CD700A08BF4CI Date: 4/11/202 3 Date: Product-Specific Terms Window Sales Window Condensation: Contractor is not responsible for condensation that may form on or within a window or between windows resulting from pre-existing conditions in Buyer's property and internal or external temperatures. Reducing the humidity in a home will often remedy any condensation problems. Roofing Sales For Flat Roofs: Due to conditions beyond Contractor's control, the structure below the roof system may allow the roof to pond water. If Buyer(s) does not opt for tapered insulation, Contractor can reduce the ponding by adding insulation and roofing material in the ponding areas at additional cost to Buyer(s). Precautions Taken by Buyer(s): Skylight openings can allow debris to enter the structure during construction. Drop cloths should be placed under skylight openings prior to commencement of roofing activity. Skylights may require removal to install new flashing. In the process of removal, drywall at the top of the shaft may crack or break, especially if it is glued to the skylight. Because this is a pre-existing condition, any drywall repair to the skylight shaft is the sole responsibility of Buyer(s). Normal roofing operation causes vibration to the structure. Contractor is not responsible for nail pops or hairline cracks in the drywall due to vibration. Buyer(s) should cover items in attic or top floor of the structure, as debris may fall. Buyer(s) should remove all fragile items prior to Contractor's commencement of work. Buyer(s) must remove solar panels, wires, and large antennas prior to Contractor's commencement of work. Contractor is not responsible for electrical work or painting. DocuSLgn Envelope ID:EOBD1436-2FBD-4693-9DF4-6286A2752AB9 Lead-Based Paint Renovation, Repair, and Painting Form Customer Name: Earl Shipp Customer Address: 62 Captain Small Road, S Yarmouth, MA, 02664 Year Home was Built: 1970 The purpose of this form is to determine if the proposed home renovation is, or is not, exempt from the Environmental Protection Agency guidelines and requirements for Lead Safe Work Practices. Occupant Confirmation of Pamphlet Receipt By initialing here, I acknowledge that I have received a copy of the pamphlet"The Lead-Safe Certified Guide to Renovate Right"informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before work began. Qualified Exemptions - Homes Built After 1977 To exempt the property as post-1977 housing, (A), (B), and (C) below shall be completed: (A)The contractor shall verify prior to commencement of work, through an independent third party(such as assessor records, housagecheck.com, Zillow.com, etc.)that the house on which the work will be performed was constructed during or after 1978. Proof of this verification shall be obtained prior to commencement of work through available public records. (B)The customer also agrees that to the best of their knowledge,the property where the work will be performed was built after 1977. (C) I agree that due to the above exemption(s), the firm will not be required to use lead-safe work practices as outlined by the EPA's Lead-Based Paint Renovation, Repair, and Painting Rule. Buyer Initials: Co-Buyer Initials: OR(Non-Exempt-Homes Built before 1977) D) I understand that the firm performing the renovation is going to follow the work practices outlined in the EPA's Lead- Based Paint Renovation, Repair, and Painting Rules. I also understand that a portion of the contract price as identified may be associated with the cost of following these guidelines. Buyer Information Co-Buyer Information Name: Earl Shipp Name: Signature: Signature: e—DoeuSigned by: PuR - ir a afe:D74/11/22b23 Date: Contractor's Representative: I certify under penalty of law that the above information is true and complete to the best of my knowledge. Name: Signature: Date: ADDITIONAL TERMS AND CONDITIONS DocuSign Envelope ID:E0BD1436-2FBD-4693-9DF4-6286A2752AB9 Delays/Unknown Conditions:Contractor's failure to perform any term of this Agreement due to conditions beyond its control such as, but not limited to, acts of God, material shortages, Buyer's inability to qualify for or obtain financing, delays by government authorities in issuing or approving inspections, permitting, or other required authorizations do not constitute abandonment and are not included in calculating time frames for performance by Contractor.The parties have determined that a definite completion date is not of the essence to this Agreement. Late Cancellation/Late Payment/Defauft: If Buyer(s) attempts to cancel this Agreement after the expiration of the applicable cancellation period afforded to Buyer(s) under this Agreement, which is 3 business days unless otherwise provide for on the accompanying notices of cancellation, and Contractor accepts such cancellation, which shall be in Contractor's sole discretion, all work will be stopped as promptly as is reasonably possible and Buyer(s)agrees to pay a cancellation fee equal to 15%of this Agreement's purchase price to offset Contractor's incurred labor,administrative,and material costs.Buyer(s)agrees to pay a late fee of 1.5%per month on all amounts due and owing from Buyer(s)to Contractor accruing from the date due and running to the date the payment is made. If Buyer(s) is in default of this Agreement, Buyer(s)agrees to pay Contractor's reasonable attorney's fees or as otherwise allowed by applicable law. Buyer(s) also agrees to pay any other costs or expenses of repossession or collection as allowed by applicable law. Contractor's Right to Cancel: In the event that Contractor determines that this Agreement cannot be performed as intended by the parties due, for example, to incorrect pricing, unforeseen structural defects, or pre-existing conditions to Buyer's property, Contractor may cancel this Agreement within thirty(30)days of its execution, notify Buyer(s)of such cancellation in writing, and return all money paid by Buyer(s). No Set-Offs or Retentions:Upon substantial completion of Contractor's work under this Agreement, Buyer(s)shall pay all amounts due under this Agreement without any right of set-off or retention. Substantial completion is defined as the job being materially completed, functional as intended, and a final inspection, permit or occupancy certificate, as the case may be, having been obtained. If after paying all amounts due, Buyer(s)alleges that Contractor's work is defective, Contractor,without waiving any of its rights, shall inspect the work and perform any remedial work to the extent Buyer(s) is entitled to under this Agreement or Contractor's warranty at no cost to Buyer(s). Buyer's Representations: Buyer(s) represents that(a) Buyer(s)owns the premises where the work is being performed; (b)to the extent not otherwise prohibited by law or indicated in this Agreement, Buyer(s)will pay all taxes and permitting fees required for Contractor to perform this Agreement;(c)Buyer(s)will provide Contractor with reasonable access to the premises,including access to electrical outlets; (d) Buyer(s) shall be responsible for the preparation, moving, and reinstalling of all service lines and the moving of any items as required by Contractor;and (e) Buyer(s)acknowledge(s)that any excess material not used by Contractor shall remain the property of Contractor. Contractor's Responsibility: Contractor accepts no responsibility for any damage resulting from pre-existing structural or other defects in Buyer's property. Contractor is not responsible for remedying structural defects. Buyer(s) acknowledges that Contractor's products do not correct or cure structural problems.Contractor shall not be responsible for(a)any damages arising in whole or in part from causes beyond control of Contractor; (b) any consequential or incidental damages including, without limitation, lost profits or reduction in value of Buyer's property arising from Contractor's delay in performing under this Agreement or due to Contractor's breach of this Agreement; and (c) unintentional damage to window treatments, landscaping, driveways, sidewalks,service lines, collateral or incidental damage to interior walls and personal property, it being understood that Buyer(s) is responsible at Buyer's cost for all preparations, protection,and/or moving of such items prior to Contractor's commencement of work. Product-Specific Terms: Depending on the product(s) purchased by Buyer(s), certain product-specific terms may apply. If applicable, these terms will be on the accompanying Specification Sheet(s). Buyer(s) acknowledges that these product-specific terms are a part of these Additional Terms and Conditions. Mold and Related Matters: Buyer(s) agrees to indemnify and hold Contractor and its employees, agents, and subcontractors harmless from any claims as to the identification,detection,abatement,encapsulation,or removal of mold,asbestos,lead-based products,or other hazardous substances inside or outside of the property at which work is performed.Contractor does not provide mold testing or remediation services. Miscellaneous:No waiver of any breach of this Agreement shall be construed as a waiver of any prior,concurrent,or subsequent breach hereof.The section headings in this Agreement are for convenience only and shall not affect in any way the interpretation AD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) 4/25/2023 4/22/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies NAMNT EACT 1185 Avenue of the Americas,Suite 2010 PHONE FAX New York NY 10036 (A/C'No• )' (A/C,No): E-MAIL 646-572-7300 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Cincinnati Insurance Company 10677 INSURER B:The First Liberty Insurance Corporation 33588 INSURED Erie Construction Mid-West,LLC 1500420 3516 Granite Circle INSURER c:Evanston Insurance Company 35378 Toledo OH 43617 INSURER D: INSURER E: INSURER F: COVERAGES 1st CERTIFICATE NUMBER: 18402199 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY), LIMITS A X COMMERCIAL GENERAL LIABILITY N N EPP0534782 4/25/2022 4/25/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY N N EBA0534782 4/25/2022 4/25/2023 COMBINED SINGLE LIMIT $ A EBA0612292 4/25/2022 4/25/2023 (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ XXXXXXx HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX $ XXXXXXX _ A x UMBRELLA LIAB X OCCUR N N EPP0534782 4/25/2022 4/25/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION _ B AND EMPLOYERS'LIABILITY Y/N N WC6-Z51-293745-022 4/25/2022 4/25/2023 X STATUTE ER PERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Excess N N MKLV1EUE101063 4/25/2022 4/25/2023 Occ:$5,000,000 Agg:$5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION See Attachment 18402199 For Your Information SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. YARMOUTH, MA, 02664 AUTHORIZED REPRIRSailA-VE h ©1988-2015 ACORD CORPORATION. I rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card ERIE CONSTRUCTION MID-WEST, INC. Registration: 159905 D/B/A ERIE METAL ROOFING Expiration: 06/18/2023 3516 GRANITE CIRCLE TOLEDO,OH 43617 Update Address and Return Card. Office of Consumer Affairs&Business Repuiation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 159905 06/18/2023 1000 Washington Street -Suite 710 ERIE CONSTRUCTION MID-WEST,INC. Boston,MA 02118 D/B/A ERIE METAL ROOFING CHADLEY SMITH 3516 GRANITE CIRCLE y ,,e,,,,ee a • TOLEDO,OH 43617 Not valid without signature Undersecretaryg